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Monday, April 2, 2012

CEO of Surgical Robot Maker “Spins” References to Favor His Product

In an
interview on a website called MassDevice, Gary Guthart, CEO of Intuitive
Surgical, maker of the Da Vinci surgical robot, offers many seemingly
persuasive arguments regarding why the robot is revolutionizing modern surgery.

Here is an
example of an interesting answer he gave to a question about a paper from the Journal of Clinical Oncology that said
robotic hysterectomy was much more expensive than standard laparoscopic
hysterectomy without demonstrable improvement in outcomes. Guthart said, “It
turns out that the paper actually entirely misses the point, in that it
compares laporoscopic [sic] to
robotics, but the reality is that what's happening in the market is robotics
are converting open procedures to robotic procedures.”

The paper didn't miss the point at all. It made the point that standard laparoscopic surgery is equal to robotic hysterectomy except for its cost.

He went on to
cite a paper in European Urology [full
text here] that he said: “covers 20,000 minimally invasive prostatectomy
surgeries – almost all of which are robotic – and it covers 60,000 open
patients. What it shows is that a length of stay for the minimally invasive arm
is reduced by 2 days and that complications – basically every complication they
measure – are less with robotic than open and mortality is significantly less
with robotics than open.”

The paper was a study of a Medicare
administrative database and compared 19,594 minimally invasive radical prostatectomies [MIRP] to 58,638 open radical
retropubic prostatectomies.

The word “robot”
is mentioned only six times in the paper, mostly in the context of this
sentence from the “Methods” section: “A unique designation for robotic assistance did not
exist during the study period; therefore, we were unable to distinguish pure laparoscopic
from robot-assisted surgery, and both were categorized as MIRP.”

It’s true
that minimally invasive surgery resulted in shorter lengths of hospital stay
and fewer complications in this paper but the patients in the minimally
invasive group were both significantly younger and had significantly fewer
co-morbidities, p for both < 0.001.

The skeptic
community still awaits a scientifically valid study that proves robotic surgery
is better than standard laparoscopic surgery for any disease.

10 comments:

I'm an ED resident, not a surgeon, but I reviewed some of the literature 2 years ago while interning with a news organization, and it seemed that all the literature in favor of robotic surgery showed an improvement in OR time. However, this was all measured in skin-to-skin time, i.e. did not include time taken to prep the gear before and after the case. Not surprisingly, all those studies were industry sponsored. Any thoughts?